Emotional adjustment post-stroke: A qualitative study of an online stroke community.

Understanding of emotional adjustment after stroke is limited. Under one-third of stroke survivors reporting emotional problems receive support. The aim of this study was to explore the process of emotional adjustment post-stroke and investigate the role played by participation in an online stroke community. We applied thematic analysis to 124 relevant posts within 114 discussion threads, written by 39 survivors and 29 carers. The contribution of online community engagement to emotional adjustment was explored using the Social Support Behaviour Code. Stroke survivors share common experiences of emotional adjustment and may not necessarily reach complete acceptance. Positive and negative trajectories of emotional adjustment were identified. Survivors progressed along, or moved between, positive and negative pathways not in a time-dependent manner but in response to "trigger events," such as physical setbacks or anti-depressant treatment, which may occur at any chronological time. An adapted version of Suhr's 1990 Social Support Behaviour Code showed that support provided through the online community took many forms, including advice, teaching, empathy and normalization of concerns. Participation in the stroke community was itself deemed to be a positive "trigger event." There is need to improve awareness of emotional adjustment and their "triggers" amongst stroke survivors, carers and clinicians.

Analysis of spontaneous, user-generated data about gestational diabetes on online forums: implications for diabetes prevention.

AIMS: To explore the experiences and perceptions of gestational diabetes mellitus reported by women within online parental-support forums and, specifically, to analyse what women say about a diagnosis of gestational diabetes, their future risk of type 2 diabetes, and lifestyle behaviour for management of gestational diabetes and prevention of type 2 diabetes. METHODS: The discussion boards of two parenting websites (Mumsnet and Netmums) were searched using the search term 'gestational diabetes or GD' in February 2019. Relevant posts made by users with gestational diabetes on or after 1 January 2017 were retained for analysis. Framework analysis using pre-existing framework from a previous study was used to organize and analyse the data. RESULTS: A total of 646 posts generated by 282 unique users were included in the analysis. Analysis of the online content identified three important implicit messages that may be being conveyed to readers. The first is that gestational diabetes is not a serious diagnosis that warrants undue concern. Secondly, few users recognized the importance of their own behaviours or lifestyle, with others minimizing personal responsibility or attributing gestational diabetes to non-modifiable factors. Finally, there was a lack of acknowledgment of heightened risk of type 2 diabetes. These three messages will all directly mitigate against the efforts of clinicians (and others) to encourage women with gestational diabetes to improve their lifestyle behaviours in the longer term. CONCLUSIONS: These findings highlight messages that are being widely disseminated and that are unlikely to support prevention of type 2 diabetes.

Economic diversification and the resiliency hypothesis: Evidence from the impact of natural disasters on regional housing values.

We estimate the effect regional economic diversification has on the resiliency of the U.S. housing market, treating the spatial and temporal variation in natural disasters as exogenous shocks to regional economies. Our study demonstrates that diversity dampens both the magnitude and the duration of the effects of a disaster on local real estate values. Implications of our findings for the potential benefits of diversification in regional economies are discussed.

Families affected by childhood cancer: an analysis of the provision of social support within online support groups.

BACKGROUND: With increasing access to the Internet, there are new opportunities available to families to seek information, advice and support about childhood cancer online. METHODS: A total of 487 messages were retrieved from three childhood cancer online support groups and were analysed using deductive thematic analysis for the presence of support-intended communication using Cutrona and Suhr's social support typology. In addition, the messages were examined for negative experiences or disadvantages. RESULTS: The results revealed the presence of five types of social support: emotional, informational, esteem support and tangible assistance. In addition, some potential limitations of online support were identified, including a lack of responses and difficulties in maintaining relationships outside the online group context. CONCLUSION: This study suggests that online support groups may offer the potential to support family members of children with cancer. In particular, it may be a useful resource for those seeking emotional and information support. However, there may be limitations associated with the use of online support groups.

Assessment of the risk of introduction of H5N1 HPAI virus from affected countries to the U.K.

The Department for Environment, Food and Rural Affairs (Defra) has monitored epidemiologic developments following outbreaks of H5N1 in Asia since the beginning of 2004 and publishes risk assessments as the situation evolves. The U.K. applies safeguard measures that reflect EU rules to enable imports to continue when they present negligible risk. Defra risk assessments (RA) identify possible pathways by which the H5N1 virus may be introduced to the U.K. These assessments provide a basis for identifying appropriate surveillance activities to ensure early detection, should the virus be introduced, and disease control measures to be taken, should the virus be detected in the U.K. Nevertheless, these assessments have highlighted that many fundamental uncertainties still remain. These uncertainties center on the geographic and species distribution of infection outside Asia and the means of dissemination of the virus. However, the evolving developments demonstrated that regulatory decisions had to be made despite these uncertainties. Improvements in our current RA abilities would greatly benefit from systematic studies to provide more information on the species susceptibility, dynamics of infection, pathogenesis, and ecology of the virus along with possible pathways by which the H5N1 virus may be disseminated. Such an approach would assist in reducing uncertainties and ensuring that regulatory risk management measures are regularly reviewed by taking into account the most recent scientific evidence. The likelihood of the persistence of H5N1 outside Asia in the coming years and the effects of control programs in Asia and other affected regions to reduce the prevalence of infection are also important factors.

Optimal Drug Policy in Low-Income Neighborhoods.

The control of drug activity currently favors supply-side policies: drug suppliers in the U.S. face a higher arrest rate and longer sentences than demanders. We construct a simple model of drug activity with search and entry frictions in labor and drug markets. Our calibration analysis suggests a strong "dealer replacement effect." As a result, given a variety of community objectives, it is beneficial to lower supplier arrests and raise the demand arrest rate from current values. A 10% shift from supply-side to demand-side arrests can reduce the population of potential drug dealers by 22-25,000 and raise aggregate local income by $380-400 million, at 2002 prices. (JEL Classification: D60, J60, K42, H70).

Persistence in the use of pharmaceuticals by the elderly. Evidence from annual claims.

An analysis of four-and-a-half years of claims data from the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) program shows a pronounced degree of persistence in annual prescription drug expense by individual enrollees from year to year, particularly among the heaviest users. There is evidence of eventual regression to the mean, but it takes a substantial length of time--far longer than observed for other types of health care used by the elderly. The study findings raise questions about the insurability of drug expenses in non-group Medigap policies.

Dynamic aspects of prescription drug use in an elderly population.

OBJECTIVE: This study explores longitudinal patterns in outpatient prescription drug use in an elderly population. DATA SOURCES/STUDY SETTING: Enrollment records and prescription drug claims were obtained for a sample of elderly Pennsylvanians (N = 27,301) who had enrolled in the Pharmaceutical Assistance Contract for the Elderly (PACE) program at any time between July 1984 and June 1987. Study Design. The study tracks monthly prescription fill rates for sampled PACE beneficiaries from their initial enrollment month through disenrollment, death, or the end of the study (whichever occurred first). We specify two-part multivariate models to assess the effect of calendar time, length of time in the PACE program, and progression to disenrollment or death both on the probability of any prescription use and on the level of use among those who filled at least one prescription claim per month. Control variables include age, gender, race, income, residence, and marital status. DATA COLLECTION/EXTRACTION METHODS: Data were extracted from administrative files maintained by the PACE program, checked for errors, and then formatted as person-month records. PRINCIPAL FINDINGS/CONCLUSIONS: We find a strong positive relationship between drug use and the length of time persons are PACE-enrolled. Persons whose death occurs within a year have much higher prescription utilization rates than do persons whose death is at least a year away, and the differential increases as death nears. Persons who fail to renew PACE coverage use significantly fewer prescription drugs in the year prior to disenrollment. Holding age and other factors constant, we find that average levels of prescription use actually declined over the study period.

Use of outpatient drugs as death approaches.

This article explores changes in outpatient prescription drug use up to 72 months prior to death and relates the findings to trends in Medicare-covered services during the same life stage. The study sample comprises 5,261 decedents who, prior to their deaths, had enrolled in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) program. Descriptive time-series show steady increases in both outpatient drug use and physician contacts in the final 36 months of life. However, multivariate analysis shows that impending death is associated with significant reductions in the probability of using outpatient drugs. Only in the final 12 months of life is this effect offset by rising numbers of drug claims by prescription users.

A paracostal approach for splenectomy in the sheep.

A modified left paracostal approach was developed to splenectomize sheep. This approach was found to be superior to the described approaches for removal of the spleen by rib resection. Since the diaphragm is in close approximation to the last rib, resection of the last rib can result in entry of the thoracic cavity, which will complicate the surgical procedure. Furthermore, rib resection necessitates the use of analgesics, due to the pain commonly associated with any orthopedic procedure, and thereby extends postoperative recovery time. The paracostal abdominal approach provides excellent exposure, ease of manipulation, reduced anesthetic time, and fewer related problems such as postoperative pain control and thoracic evacuation. A major benefit of the paracostal approach is the minimal need for analgesic support as evidenced by the animals' rapid return to normal function. This bypasses the need for extended recovery, as required in the rib resection approach, and allows earlier utilization of the animal for research.

Physiological responses of sheep to two hours anaesthesia with diazepam-ketamine.

The cardiopulmonary effects of repeated intravenous injections of a combination of diazepam and ketamine for anaesthesia were evaluated in six domestic sheep. Induction doses of 0.375 mg/kg and 7.5 mg/kg were followed by maintenance doses of 0.188 mg/kg and 3.75 mg/kg every 15 minutes for 105 minutes. Although this dosing regimen produced the desired anaesthetic effects, it caused untoward cardiopulmonary effects. Salient features of multiple dosing with diazepam and ketamine were hypoventilation, respiratory acidosis and an increase in both systemic and pulmonary vascular resistance.